Finkler超声评分、血流参数结合肿瘤标志物检测对良恶性卵巢肿瘤的诊断价值研究
摘要
目的探讨分析Finkler超声评分、血流参数及肿瘤标志物检查及三者联合在良恶性卵巢肿瘤诊断方面的价值,以期寻找超声检查声像图与肿瘤标志物在卵巢肿瘤分型上的线索,为卵巢肿瘤患者的临床治疗提供影像学依据和预后评估提供可靠标准。方法对2016年7月-2018年6月在该院经术后病理证实的100例卵巢肿瘤患者进行术前超声检查及肿瘤标志物CA199、CA125检测,参照Finkler超声评分标准,对超声检查结果进行评分,评分≥7分设为恶性组,<7分设为良性组;根据彩色多普勒超声检查的阻力指数(RI)标准,<0. 45设为恶性组;以肿瘤标志物CA199>37 U/ml、CA125>35 U/ml为临界标准来区分是否为卵巢恶性肿瘤。以术后病理作为金标准,分别计算各项检查及三项检查联合的灵敏度、特异度、阳性预测值、阴性预测值。针对结果进行分析并找出影像数据与CA199、CA125之间在卵巢肿瘤分型上的相关性。结果总计100例卵巢肿瘤患者,病理证实恶性33例,良性67例。按Finkler超声评分标准检出恶性37例,良性63例;根据RI诊断标准检出恶性39例,良性61例;根据血清肿瘤标志物CA199、CA125诊断标准检出恶性38例,良性62例; Finkler评分+RI+肿瘤标记物检出恶性35例,良性65例。Finkler超声评分结果的准确度为90. 00%,灵敏度为90. 90%,特异度为89. 55%,阳性预测值为81. 08%,阴性预测值为95. 23%,Youden指数为0. 80。RI结果的准确度为84. 00%,灵敏度为84. 84%,特异度为83. 58%,阳性预测值为71. 80%,阴性预测值为90. 80%,Youden指数为0. 68。CA199、CA125结果的准确度为87. 00%,灵敏度为87. 80%,特异度为86. 56%,阳性预测值为76. 31%,阴性预测值为93. 55%,Youden指数为0. 74。Finkler评分+RI+CA199、CA125结果的准确度为94. 00%,灵敏度为93. 93%,特异度为97. 01%,阳性预测值为88. 57%,阴性预测值为96. 92%,Youden指数为0. 91。结论Finkler超声评分、RI在一定程度上能诊断出卵巢肿瘤的良恶性,具有肯定价值,可以作为筛查时的主要检查手段,但其灵敏度较低。联合CA199、CA125检查能提高卵巢肿瘤良恶性检出的灵敏度、特异度,在早期鉴别诊断卵巢肿瘤方面具有较大优势。
引文
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[11]戴晴.卵巢恶性肿瘤的超声评价及研究进展[J].肿瘤影像学,2016,25(1):1-5.
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[13]Petri AL,H?gdall E,Christensen IJ,et al.Preope rative CA125as a prognostic factor in stage I epithelial ovariancancer[J].AP-MIS,2006,114(5):359-363.
[14]Yu X,Cohen J,Deshmukh H,et al.The association of serial ultrasounds and CA125 prior to diagnosis of ovarian cancer-Do they improve early detection[J].Gynecol Oncol,2008,111(2):385.
[15]张铭娜,徐娟,高燕,等.血清CA199在上皮性卵巢癌中的临床意义[J].天津医药,2009,37(3):186.
[16]钱林华,高燕,李惠东,等.超声联合CA125、CA199诊断早期上皮性卵巢癌的临床价值[J].天津医科大学学报,2010,16(3):502-505.
[2]Carley ME,Klingele CJ,Gebhart JB,et al.Laparoscopy versus laparotomy in the management of benignunilateral adnexal masses[J].JAm Assoc Gynecol Laparosc,2002,9(3):321-326.
[3]Tessitore A,Gaggiano A,Cicciarelli G,et al.Serumbiomarkers identification by mass spectrometry in high-mortality tumors[J].Int J Proteomics,2013,2013:125858.
[4]陈莹,汪俊红,邱忠君.超声评分联合血清CA125鉴别卵巢良恶性肿瘤的价值研究[J].河北医科大学学报,2015,36(9):1030-1032.
[5]Li J,Dowdy S,Tipton T,et al.HE4 as a biomarker for ovarian and endometrial cancer management[J].Expert Rev Mol Diagn,2009,9(6):555-566.
[6]Finkler N,Benacerraf B,Lavin P,et al.Comparison of seram CAl25,clinical impression and ultrasound in the preoperative evaltion of ovarian masses[J].Obstet Gynecol,1988,72(4):659-662.
[7]郭权,张忠福,张淑兰,等.Finkler超声评分法在卵巢肿瘤鉴别中的应用[J].辽宁医学杂志,2002,16(4):178-180.
[8]Kaijser J.Towards an evidence-based approach for diagnosis and management of adnexal masses:findings of the International Ovarian Tumour Analysis(IOTA)studies[J].Facts Views Vis Obgyn,2015,7(1):42-59.
[9]Van Calster BV,Hoorde KV,Valentin L,et al.Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign,borderline,early and advanced stage invasive,and secondary metastatic tumours:prospective multicentre diagnostic study[J].BMJ,2014,349:5920.
[10]王新燕,唐桂波.彩色多普勒超声血流阻力指数结合CA125对卵巢肿瘤的诊断价值[J].中国医学影像学杂志,2012,20(9):692-699.
[11]戴晴.卵巢恶性肿瘤的超声评价及研究进展[J].肿瘤影像学,2016,25(1):1-5.
[12]Kurjak A,Kupesic S,Sparac V,et al.The detection of stage I ovarian cancer by three-dimensional sonography and power Doppler[J].Gynecol Oncol,2003,90(2):258-264.
[13]Petri AL,H?gdall E,Christensen IJ,et al.Preope rative CA125as a prognostic factor in stage I epithelial ovariancancer[J].AP-MIS,2006,114(5):359-363.
[14]Yu X,Cohen J,Deshmukh H,et al.The association of serial ultrasounds and CA125 prior to diagnosis of ovarian cancer-Do they improve early detection[J].Gynecol Oncol,2008,111(2):385.
[15]张铭娜,徐娟,高燕,等.血清CA199在上皮性卵巢癌中的临床意义[J].天津医药,2009,37(3):186.
[16]钱林华,高燕,李惠东,等.超声联合CA125、CA199诊断早期上皮性卵巢癌的临床价值[J].天津医科大学学报,2010,16(3):502-505.